重庆农村地区根除幽门螺杆菌优化方案研究-东南大学学报医学版

重庆农村地区根除幽门螺杆菌优化方案研究

单位：1. 贵州省人民医院消化内科, 贵州贵阳 550001;
2. 重庆市三峡中心医院消化内科, 重庆 404000;
3. 重庆市垫江县人民医院消化内科, 重庆 408300;
4. 重庆市黔江中心医院消化内科, 重庆 409000;
5. 重庆市綦江县人民医院消化内科, 重庆 401420;
6. 重庆医

关键词：幽门螺杆菌感染优化治疗方案根除率

分类号：R573

出版年·卷·期（页码）：2019·38·第三期（397-401）

摘要：

目的：基于前期对重庆农村地区幽门螺杆菌（Hp）的耐药情况和CYP2C19基因多态性调查，筛选出优化的治疗方案，观察对Hp的根除效果及安全性，为重庆农村地区选择合适的抗Hp治疗方案提供理论依据。方法：选取2015年6月至2016年1月Hp阳性农村患者270例，按照不同治疗方案随机分为3组各90例：A组采用雷贝拉唑0.02 g/埃索美拉唑0.02 g+呋喃唑酮0.10 g+铋剂0.20 g+阿莫西林1.0 g方案；B组采用兰索拉唑0.03 g/泮托拉唑0.04 g+呋喃唑酮0.10 g+铋剂0.20 g+阿莫西林1.0 g方案；C组采用雷贝拉唑0.02 g/埃索美拉唑0.02 g+克拉霉素0.50 g+阿莫西林1.0 g方案。均每天给药2次，连续治疗14 d，治疗结束后4周行¹³C/¹⁴C-尿素呼气试验并比较3组患者的Hp根除率、临床症状缓解情况及不良反应。结果：A与C组的根除率差异有统计学意义[按意向治疗（ITT）分析，χ²=7.273，P=0.007；按方案治疗（PP）分析，χ²=9.745，P=0.002）]，A组与B组间及B组与C组间差异无统计意义（P>0.05）。A组和B组临床症状缓解率均高于C组（χ²=5.180，P=0.023；χ²=5.066，P=0.024）。3组间不良反应发生率差异无统计学意义（P>0.05），各组均未出现严重不良反应。结论：雷贝拉唑/埃索美拉唑+呋喃唑酮+铋剂+阿莫西林的四联方案具有较高的Hp根除率，可改善患者临床症状，无明显的不良反应，可用于重庆农村Hp感染患者经验性治疗。

Objective:To observe the eradication effect and safety in the treatment of Helicobacter pylori(Hp) based on the previous investigation and to provide theoretical basis for the selection of appropriate anti-Hp treatment scheme in rural areas of Chongqing. Methods:Two hundred and seventy patients infected with Hp from May 2015 to January 2016 in Chongqing rural areas were enrolled in this study and were randomly assigned into three groups, i.e., group A(n=90) treated with rabeprazole/esomeprazole+furazolidone+bismuthpotassium+amoxicillin, groupB(n=90)treated with lansoprazole/pantoprazole+furazolidone+bismuth potassium+amoxicillin and group C(n=90) treated with rabeprazole/esomeprazole+clarithromycin+amoxicillin. Patients in group A received rabeprazole 0.02 g/esomeprazole 0.02 g, furazolidone 0.10 g, bismuth potassium 0.20 g and amoxicillin1.0 g, twice daily for 14 days. Patients in group B received pantoprazole 0.04 g/lansoprazole 0.03 g, furazolidone 0.10 g, bismuth potassium 0.20 g and amoxicillin 1.0 g twice daily for 14 days, and patients in group C received rabeprazole 0.02 g/esomeprazole 0.02 g, clarithromycin 0.50 g and amoxicillin 1.0 g,twice daily for 14 days. Four weeks after therapy, all patients underwent ¹³C/¹⁴C test. The eradication rate, remission rate and the adverse effects of the three groups were recorded and compared. Results:The Hp eradication rate in group A was significantly higher than that in group C(P<0.05). The remission rates of clinical symptoms in group A and B were higher than those in group C(P<0.05). There were no significant differences in the incidence of adverse reactions among the 3 groups(P>0.05). Conclusion:The 14-d quadruple therapy(rabeprazole/esomeprazole combined with bismuth, furazolidone and amoxillicin) achieves satisfactory Hp eradication rates with no adverse reaction,which can be recommended as empirical therapy for Hp eradication in rural population of Chongqing.

参考文献：

[1] FRANCESCHI F,GASBARRINI A,POLYZOS S A,et al.Extragastric diseases and Helicobacter pylori[J].Helicobacter,2015,20(Suppl 1):40-46.
[2] FORD A C,FORMAN D,HUNT R H,et al.Helicobacter pylori eradication therapy to prevent gastric cancer in healthy asymptomatic infected individuals:systematic review and meta-analysis of randomised controlled trials[J].BMJ,2014,348(4):g3174.
[3] MIENDJE-DEYI V Y,BONTEMS P,VANDERPAS J,et al.Multicenter survey of routine determinations of resistance of Helicobacter pylori to antimicrobials over the last 20 years(1990 to 2009) in Belgium[J].J Clin Microbiol,2011,49(6):2200-2209.
[4] WANG B,LV Z F,WANG Y H,et al.Standard triple therapy for Helicobacter pylori infection in China:a meta-analysis[J].World J Gastroenterol,2014,20(40):14973-14985.
[5] HAN R,LAN C,WU X,et al.Multicenter study of antibiotic resistance profile of H.pylori and distribution of CYPC19 gene polymorphisms in rural population of Chongqing,China[J].Gastroenterol Res Pract,2016,2016(4):1-6.
[6] XIE Y,ZHU Y,ZHOU H,et al.Furazolidone-based triple and quadruple eradication therapy for Helicobacter pylori infection[J].World J Gastroenterol,2014,20(32):11415-11421.
[7] MOAYYEDI P,HUNT R H.Helicobacter pylori public health implications[J].Helicobacter,2004,9(Suppl 1):67-72.
[8] 张万岱,胡伏莲,萧树东,等.中国自然人群幽门螺杆菌感染的流行病学调查[J].现代消化及介入诊疗,2010,15(5):265-270.
[9] MALFERTHEINER P,MEGRAUD F,O'MORAIN C,et al.Current European concepts in the management of Helicobacter pylori infection——the Maastricht Consensus Report.The European Helicobacter Pylori Study Group(EHPSG)[J].Eur J Gastroenterol Hepatol,1997,9(1):1-2.
[10] ZHOU L,ZHANG J,CHEN M,et al.A comparative study of sequential therapy and standard triple therapy for Helicobacter pylori infection:a randomized multicenter trial[J].Am J Gastroenterol,2014,109(4):535-541.
[11] MALFERTHEINER P,BAZZOLI F,DELCHIER J C,et al.Helicobacter pylori eradication with a capsule containing bismuth subcitrate potassium,metronidazole,and tetracycline given with omeprazole versus clarithromycin-based triple therapy:a randomised,open-label,non-inferiority,phase 3 trial[J].Lancet,2011,377(9769):905-913.
[12] 刘文忠,谢勇.第四次全国幽门螺杆菌感染处理共识报告[J].中华内科杂志,2012,17(10):832-837.
[13] MALFERTHEINER P,MEGRAUD F,O'MORAIN C A,et al.Management of Helicobacter pylori infection-the Maastricht Ⅳ/Florence Consensus Report[J].Gut,2012,61(5):646-664.
[14] 成虹,胡伏莲,谢勇,等.中国幽门螺杆菌耐药状况以及耐药对治疗的影响-全国多中心临床研究[J].胃肠病学,2007,12(9):525-530.
[15] GOH K L,NAVARATNAM P.High Helicobacter pylori resistance to metronidazole but zero or low resistance to clarithromycin,levofloxacin,and other antibiotics in Malaysia[J].Helicobacter,2011,16(3):241-245.
[16] SUN Q J,LIANG X,ZHENG Q,et al.Resistance of Helicobacter pylori to antibiotics from 2000 to 2009 in Shanghai[J].World J Gastroenterol,2010,16(40):5118-5121.
[17] FURUTA T,SUGIMOTO M,SHIRAI N,et al.CYP2C19 pharmacogenomics associated with therapy of Helicobacter pylori infection and gastro-esophageal reflux diseases with a proton pump inhibitor[J].Pharmacogenomics,2007,8(9):1199-1210.
[18] DE MORAIS S M,WILKINSON G R,BLAISDELL J,et al.Identification of a new genetic defect responsible for the polymorphism of (S)-mephenytoin metabolism in Japanese[J].Mol Pharmacol,1994,46(4):594-598.
[19] SERRANO D,TORRADO S,TORRADO-SANTIAGO S,et al.The influence of CYP2C19 genetic polymorphism on the pharmacokinetics/-pharmacodynamics of proton pump inhibitor-containing Helicobacter pylori treatments[J].Curr Drug Metab,2012,13(9):1303-1312.

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